Use of Computer Decision Support in an Antimicrobial Stewardship Program (ASP)

Abstract

SummaryObjective: Document information needs, gaps within the current electronic applications and reports, and workflow interruptions requiring manual information searches that decreased the ability of our antimicrobial stewardship program (ASP) at Intermountain Healthcare (IH) to prospectively audit and provide feedback to clinicians to improve antimicrobial use. Methods: A framework was used to provide access to patient information contained in the electronic medical record, the enterprise-wide data warehouse, the data-driven alert file and the enterprise-wide encounter file to generate alerts and reports via pagers, emails and through the Centers for Diseases and Control's National Healthcare Surveillance Network. Results: Four new applications were developed and used by ASPs at Intermountain Medical Center (IMC) and Primary Children's Hospital (PCH) based on the design and input from the pharmacists and infectious diseases physicians and the new Center for Diseases Control and Prevention/ National Healthcare Safety Network (NHSN) antibiotic utilization specifications. Data from IMC and PCH now show a general decrease in the use of drugs initially targeted by the ASP at both facilities. Conclusions: To be effective, ASPs need an enormous amount of "timely" information. Members of the ASP at IH report these new applications help them improve antibiotic use by allowing efficient, timely review and effective prioritization of patients receiving antimicrobials in order to optimize patient care.

In Data We Trust? Comparison of Electronic Versus Manual Abstraction of Antimicrobial Prescribing Quality Metrics for Hospitalized Veterans With Pneumonia

“…Measuring practice is a key feature of a learning health system, and increasingly advanced computational capabilities provide the opportunity for replicable system-wide evaluations,(23) decision support for stewardship,(30) and quality improvement. However, clinical data must not be taken at face value.…”

Antimicrobial Resistance and Antimicrobial Stewardship in Home Healthcare

“…Looking toward the future, as technology advances toward EMR integration across healthcare settings, systems can be designed to facilitate many AS strategies. For instance, educational strategies may be embedded into the EMR as a link to the antimicrobial guidelines, or electronic integration of patient-specific laboratory and microbiology results with suggested antimicrobial agents (Evans et al, 2015). In addition, the electronic function can be built into the EMR to minimize usage of restricted agents by giving a list of alternative regimes or prompt an alert to seek an authorization whenever a prescriber places an order for restricted antimicrobials.…”